JP6078052B2 - Bilateral knee device (BI-CRUCIATEKNEESYSTEM) - Google Patents

Description

Cross-reference of related applications
[0001] This application claims priority to US patent application No. 13 / 470,630, filed May 14, 2012, as well as US Provisional Patent Application No. 61/486, filed May 13, 2011. No. 61,593,521 and US Provisional Patent Application No. 61 / 593,521 filed on Feb. 1, 2012. The entire disclosure of the above application is incorporated herein by reference.

  [0002] The following disclosure generally describes knee surgery, and more particularly, instruments, implants, and related devices for preparing a knee for a bi-cruciate knee implant The method is described.

[0001] This section provides a general overview of the disclosure and does not provide a comprehensive disclosure of the full scope of the invention or all features of the invention.
[0002] An instrument set for preparing a proximal tibia during a bilateral (in other words, anteroposterior cruciate ligament) retention procedure can include a tibial resection block, a vertical cutting guide, and a locking arm. The tibial resection block can be configured to be secured to the anterior portion of the proximal tibia. The tibial resection block may define a slot that extends in a medial-lateral direction when the tibial resection block is secured to the proximal tibia. The vertical cutting guide can have a body, an inner arm and an outer arm. An inner cutting slot can be defined between the body and the inner arm. An outer cutting slot can be defined between the body and the outer arm. The cutting guide can further comprise a tongue extending from the cutting guide. The tongue can be configured to enter the slot of the tibial resection block and translate while sliding along the slot. The locking arm can be attached to the cutting guide and is movable between an unlocked position and a locked position. In the unlocked position, the cutting guide can be translated relative to the tibial resection block. In the unlocked position, the locking arm can engage the tibial resection block to prevent the cutting guide from moving relative to the tibial resection block.

  [0003] According to an additional feature, the locking arm can rotate between an unlocked position and a locked position relative to the cutting guide. The locking arm can include a finger extending from the locking arm that engages the tibial resection block when in the locked position. The body of the cutting guide can be open with an inner cutting slot and an outer cutting slot. The inner cutting slot and the outer cutting slot can terminate with a partial hole configured to receive a pin. The body of the cutting guide may have an upper inner wall and an upper outer wall. The instrument set may further comprise an alignment guide, the alignment guide having elongated arms configured to be installed on both sides of the cutting guide body. The instrument set may further comprise a tibial resection guide, the tibial resection guide having a stylus configured to engage the lowest point of the medial tibial plateau.

  [0004] A method of preparing a proximal tibia for a bilateral implant may include determining a resection height of the proximal tibia. The tibial cutting block can be secured to the proximal tibia based on this determination. The vertical cutting guide can be translated while being slid along the slot defined in the tibial cutting block until the desired in-out position relative to the proximal tibia is obtained. By obtaining the desired inward and outward position, the vertical cutting guide can be fixed relative to the tibial cutting block. The vertical medial cut can be prepared in the proximal tibia with reference to the medial slot defined in the vertical cutting guide (in other words, with reference). The vertical outer cut can be prepared in the proximal tibia with reference to the outer slot defined in the vertical cutting guide.

  [0005] According to additional features, the method can further include placing a tongue extending from the vertical cutting block into a slot of the tibial cutting block. The locking arm extending from the vertical cutting guide can be moved from the unlocked position to the locked position. In the locked position, fingers extending from the arms can engage the tibial cutting block. The locking arm can be rotated relative to the vertical cutting guide from the unlocked position to the locked position. The medial side of the proximal tibia can be cut horizontally. A spacer can be positioned on the resected medial side of the proximal tibia. The inner side gap can be confirmed. The lateral side of the proximal tibia can be resected horizontally. A spacer can be positioned on the resected lateral side of the proximal tibia. The outer side gap can then be confirmed. At least one pin can be advanced through the hole defined in the vertical cutting guide and into the proximal tibia. Pins can be referenced when preparing vertical, inner and outer cuts. The pin can prevent undercutting of the ACL island.

  [0006] According to other features, the anterior tibial bone can be removed after preparing the step of horizontally resecting the medial and lateral sides. The proximal tibia can be dimensioned by placing a tibial template on the proximal tibia. The tibial template can have a U-shaped body, an inner passage and an outer passage, and an inner cutting guide and an outer cutting guide. An anterior hole can be prepared in the tibia with reference to the inner and outer drill guides in the tibial template. Keel holes can be prepared in the tibia with reference to the medial and lateral passages in the tibial template. A tibial tray trial insert coupled to a tibial tray trial can be positioned on the proximal tibia. A peg extending from the trial insert can be installed in the front hole. A keel extending from the trial insert can be placed in the keel hole.

  [0007] Other areas of applicability will become apparent from the description herein. This summary description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.

[0008] The drawings described herein are for the purpose of illustrating selected embodiments only and are not intended to be exhaustive of all possible examples, and are not intended to limit the scope of the present disclosure.
[0009] FIGS. 1-49 illustrate tibial preparation according to one example taught by the present application.

[0010] FIG. 1 is a perspective view of an exemplary 4-in-1 cutting block with an ACL (anterior cruciate ligament) protector that can be selectively attached. [0011] FIG. 2 is a perspective view of the 4-in-1 block of FIG. [0012] FIG. 3A is an anterior view of an exemplary tibia before the tibia preparation is performed. [0013] FIG. 4 is an anterior view of the tibia of FIG. 3 after tibia preparation. [0014] FIG. 3 is an anterior perspective view of the tibia showing an extramedullary tibial resection guide attached to the tibia. [0015] FIG. 5 is an anterior perspective view of the proximal tibia, with the tibial resection block attached to the extramedullary tibial resection guide and installed in contact with the proximal tibia. [0016] FIG. 9 is a medial perspective view of the proximal tibia of FIG. 8 with the end of the modular stylus engaged to the lowest point of the medial tibial plateau. [0017] FIG. 5 is an anterior perspective view of the proximal tibia showing the modular stylus positioned so that the terminal end of the modular stylus engages the lowest point of the medial tibial plateau. [0018] FIG. 9 is an anterior perspective view of the proximal tibia of FIG. 8 showing the tibial resection block attached to a modular stylus adjusted to the desired location. [0019] FIG. 9 is an anterior perspective view of the proximal tibia showing a vertical cutting guide attached to the tibial resection block in alignment with the ACL and the tibial island. [0020] FIG. 11 is an anterior view of the tibia of FIG. 10 showing a vertical cutting guide attached to the tibial resection block in the locked position. [0021] FIG. 7 is an anterior view of the proximal tibia after a pair of vertical cuts have been made that form the medial and lateral sides of an ACL island made with reference to the vertical cut guide. . [0022] FIG. 6 is a top view of the tibia showing a pre-trial spacer placed on the outer plateau to confirm the height of the resected tibia bone. [0023] FIG. 14 is an anterior perspective view of the proximal tibia and pretrial spacer shown in FIG. [0024] FIG. 10 is a top view of the proximal tibia, with the bone forceps tool initially installed to resect the anterior portion of the tibia. [0025] FIG. 16 is an enlarged view of the front portion of the ACL island of FIG. [0026] FIG. 16 is an anterior perspective view of the proximal tibia of FIG. [0027] FIG. 18 is an anterior perspective view of the tibia of FIG. 17 showing a file being used to finish the surface surrounding the ACL island after the anterior island has been resected. [0028] FIG. 7A is a front perspective view of the proximal tibia showing a tibial plateau angle gauge placed on the proximal tibia. [0029] FIG. 20 is an enlarged view of the scale of the tibial plateau angle gauge of FIG. [0030] FIG. 6 is a perspective view of a spacer tool used to identify the inner and outer gaps. [0031] FIG. 10 is a top view of the proximal tibia showing the use of an optional anteroposterior dimension measuring device to confirm the dimensions of the tibia. [0032] FIG. 23 is an enlarged view of the scale of the dimension measuring device shown in FIG. [0033] FIG. 7 is a perspective view of the proximal tibia showing the tibial template and anteroposterior dimension measuring device being placed over the proximal tibia and being used to verify dimensions, rotation, and tilt. It is. [0034] FIG. 25 is an exterior view of the proximal tibia showing the tibial template and anteroposterior dimension measuring device of FIG. 24 placed on the proximal tibia. [0035] Anterior perspective view of the proximal tibia showing the tibial template placed over the proximal tibia and with the drill aligned to enter the medial anterior drill guide of the tibial template FIG. [0036] FIG. 10 is an exploded front perspective view of a tibial mask and a tibial template. [0037] FIG. 7 is an anterior perspective view of the proximal tibia showing the toothbrush keel blade positioned to enter the medial passage provided in the tibial template. [0038] FIG. 29 is an anterior view of the proximal tibia of FIG. 28 showing a toothbrush keel blade inserted into the medial passage of the tibial template while forming an inner groove in the tibia. [0039] FIG. 9 is a front perspective view of a tibial tray trial and a tibial tray trial insert constructed in accordance with an example taught by the present invention. [0040] FIG. 12 is a front perspective view showing the assembled position of the tibial tray trial and the tibial tray trial insert. [0041] FIG. 14 is an anterior perspective view of a prepared proximal tibia showing a tibial tray trial and a tibial tray trial insert installed on the tibia. [0042] FIG. 12 is a medial perspective view of the proximal tibia showing a tibial bearing trial handle and a tibial impactor attached to a tibial tray trial. [0043] FIG. 34 is an anterior perspective view of the proximal tibial and bearing trial handle tool of FIG. [0044] FIG. 35 is an anterior perspective view of the proximal tibia of FIG. 34 showing the bearing trial handle tool with the bearing positioned over the tibial tray. [0045] FIG. 36 is a front perspective view of the proximal tibia of FIG. 35, showing the medial and lateral bearings attached to the tibial tray. [0046] FIG. 37 is a front perspective view of the tibial tray of FIG. 36 showing a range of motion using a femoral trial.

[0047] Corresponding reference numbers indicate corresponding parts throughout the several views of the drawings.
[0048] The following description will focus on preparing the left knee to accept a bilateral knee implant. In this regard, the following description is directed to various methods and procedures using an instrument that prepares the left knee using a bilateral knee device. However, it will be appreciated that the same may be applied for use on the right knee.

  [0049] Although this application is intended to focus specifically on tibial preparation and associated implants, an outline of an example of preparing the left femur will be described. Anterior-posterior image radiographs may be used to assess bone stock, potential ligament instability, and anatomical axes. In some examples, an up-and-down image radiograph 91 cm (36 inches) long may be used. Initially, the angle between the anatomical axis and the mechanical axis may be measured while ensuring that the distal femoral cut is perpendicular to the mechanical axis. At this point, the dimensions of the femoral component can be estimated prior to surgery using lateral radiographs and radiographic templates. Appropriately dimensioned femoral components may be verified during surgery.

  [0050] An intramedullary (IM) drill may be used to penetrate the distal femoral intercondylar notches and dense cancellous bone to a depth of about 1.5 to 2 inches. A 0.975 cm (0.375 inch) drill may be used to penetrate the distal femur. The location of the tube entrance may be 1 centimeter above the posterior ligament attachment and slightly inside the intercondylar notch. An appropriate left or right valgus wing may be selected and slid to attach to the IM rod. An IM rod may be introduced into the femoral canal to decompress the tube. The Vargas wing may be slid until it hits the distal medial condyle and stops. Slidex (Slidex®) distal resection block and cutting block adapter are both slid into the anterior hole of Vargas wing until the slidex distal resection block contacts the anterior cortex of the femur.

  [0051] To verify the valgus angle, an alignment handle can be inserted into the cutting block adapter and a 0.635 cm (1/4 inch) alignment rod can be inserted and extended to the center of the femoral head. The slidex distal excision block can then be pinned in place using a 0.318 cm (1/8 inch) quick release drill pin contained in the block's most proximal pin hole. Next, removing the Vargas wing is done by removing the IM rod and pulling the Vargas wing and cutting block adapter away from the distal ablation block, leaving the slidex distal ablation block in place. Can do. Two ablation slots of 0 or +3 mm are available for distal ablation. The 0 mm slot excises 9 mm from the most protruding portion of the distal medial condyle. If further distal excision is required, the +3 mm slot will excise 12 mm. If further distal excision beyond the +3 mm slot is required, a +2 or +4 mm 0.318 cm (1/8 inch) pin hole can be utilized to shift the ablation guide proximally. A 0.137 cm (0.054 inch) saw blade can be used to complete the distal ablation through the selected slot. The resected distal femur can be examined using a flat instrument. The bone surface may be cut again or filed as needed to ensure correct excision. To further stabilize, a femoral block handle can be utilized.

  [0052] An exemplary method for measuring femoral dimensions will now be described. Initially, an adjustable anteroposterior dimension meter may be applied to the resected distal surface and placed with the foot in contact with the posterior condyle of the femur. In the first option, a fixed rotating foot may be used. In another option, an adjustable rotating foot may be used. An adjustable rotary scale can be used with the front-rear dimension measuring instrument. The adjustable rotating foot can vary from side to side and the setting can be set by rotating 0 to 10 degrees outward. In one example, it is recommended to use the setting with the initial rotation of 3 degrees. The femoral component dimensions can now be read from the center scale. If the indicated dimensions are within the standard dimension range, or if a larger flexion gap is desired, choose a smaller dimension and choose to place the femur 4-in-1 block offset forward Also good. In order to shift the component to the front side, the height of the drill hole is raised by 1 mm by turning the screw mechanism in the central part of the dimension measuring instrument. A scale is placed on the dimension measuring instrument to indicate how far the component will be displaced. If the medial / external width is a concern, an appropriately sized medial / external width tester can be inserted into the anteroposterior dimension measuring device to further evaluate the appropriate size of the femur. Next, two 4-in-1 cutting block mounting holes are drilled using a 1/8 inch drill pin. In one example, the final internal and external positions of the femoral component are not determined at this stage and are addressed after this procedure.

  [0053] Referring initially to FIGS. 1 and 2, the initial preparation of the distal femur using a 4-in-1 block 10 in accordance with the teachings of the present invention will now be described. First, the surgeon selects the desired 4-in-1 block 10 that fits the dimensions selected by the anteroposterior dimensioner and places it in a 1/8 inch hole drilled in the distal femur. Can do. A 0.14 cm (0.054 inch) feeler blade can be used to measure the amount of anterior bone resection. If the feeler blade indicates the possibility of notching, the cutting block hole may be adjusted by 1 mm forward using an anteroposterior femoral shift block. As the block is moved anteriorly, the posterior condyles are further excised. A 0.318 cm (1/8 inch) pin can be placed in the side hole in the femur 4 in 1 block 10. The anteroposterior block must be positioned at this point in direct contact with the distal femur. The ACL protector 12 may be fixed at a predetermined location with respect to the 4-in-1 block 10. The ACL protector 12 can be used to prevent the blade from inadvertently cutting the ACL. When the position of the 4-in-1 block 10 is satisfactory, the surgeon can excise the anterior and posterior bones and anterior and posterior chamfers using a 0.054 inch saw blade. Again, care must be taken not to cut the ACL when cutting the bones of the front and rear chamfers.

  [0054] Referring now to FIGS. 3 to 37, the preparation of a proximal tibia for a bilateral knee device according to a first embodiment will be described. FIG. 3 illustrates the tibia T1 prior to performing this surgical procedure. FIG. 4 illustrates the tibia T2 after performing the tibial procedure according to the teachings of the present application. The tibia T2 includes an inner plateau 14, an outer plateau 16, an anterior plateau 18, an anterior chamfer wall portion 20, an inner vertical wall portion 22, and an outer vertical wall portion 24. The front chamfer wall 20, the inner vertical wall 22, and the outer vertical wall 24 can work together to form the ACL island 28. A radius 30 is formed at the transition between the inner plateau 14 and the inner vertical wall 22. Similarly, a round 32 is formed at the transition between the outer plateau 16 and the outer vertical wall 24.

  [0055] The resection of the tibia T will now be described with reference to FIGS. With the knee flexed, the spring-loaded arms 36 and 38 of the ankle joint clamp 40 are placed around the distal tibia T, just around the ankle. The tarsal joint clamp 40 can generally be attached to an extramedullary tibial resection guide 42. The extramedullary tibial resection guide 42 can further comprise a handle portion 44, a telescoping rod portion 46, and a resection block coupling portion 48. A push button 50 can be provided on the extramedullary tibial resection guide 42, which can control the entire telescopic movement of the rod portion 46 from the handle portion 44.

  [0056] At this point, the tibial resection block 54 (FIG. 6) can be placed against the proximal tibia T. Returning now to FIG. 5, the side surface of the extramedullary tibial resection guide 42 is adjusted to be substantially parallel to the axis of the tibia T when viewed from the sagittal direction. The tibial resection block is set to tilt 4 degrees when attached to the extramedullary guide (other sizes may be used). When the resection axis adjustment is correct when viewed inward and outward, the resection block connection 48 is rotated until the resection shaft is just inside the tibial nodule. Using the stylus 60 (FIGS. 7 and 8), the extramedullary tibial resection guide 42 is adjusted so that the distal end 62 of the stylus 60 engages the lowest point of the medial tibial plateau 64. The extramedullary tibial resection guide 42 is secured to the tibia T using a 0.318 cm (1/8 inch) pin 66. The rotary scale 68 may be used to fine tune the height of excision before making any cut (FIG. 9).

  [0057] Note that the stylus 60 is set for 4 mm resection. Before pinning the extramedullary tibial resection guide 42 in place, it must be possible to adjust the height of the tibial resection cutting block 70. The tibial resection block 70 can define a horizontal slot 71. Once the height to be cut is set, the stylus 60 can be removed. A vertical cutting guide 72 can then be attached to the tibial resection block 70 (FIG. 10).

  [0058] Next, the vertical cutting guide 72 can be adjusted to an appropriate position (inward and outward along the slot 71) to make the desired vertical cutting. Specifically, the tongue 72 a extending from the vertical cutting guide 72 can be slid along the slot 71. An alignment guide 73 can be used to assist in positioning the vertical cutting guide 72. The alignment guide 73 generally includes a pair of parallel and elongated arm portions 73 a that are slidably installed on both sides of the vertical cutting guide 72. Note that the vertical cut determines the final rotation of the tibial component. It is important to leave an equal amount of bone on the inner and outer portions of the ACL fibers. At this point, the vertical cutting guide 72 can be clamped in place by turning the locking arm 72b from the unlocked position shown in FIG. 10 to the locked position shown in FIGS. In one example, the locking arm 72b may have a finger 72c that rotates and engages and engages the upper surface 72d of the cutting block 70. When a reciprocating saw is used, the vertical inner cutting portion 74 can be prepared while passing a saw through an inner slot 75a defined between the main body 75b of the vertical cutting guide 72 and the inner arm portion 75c. The vertical inner cutting portion 74 may be prepared with reference to the inner surface 75 of the vertical cutting guide 72. It will be appreciated that the vertical inner cut 74 may be prepared with reference to the inner arm 75c at the same time. After preparing the vertical inner cutting portion 74, the vertical outer cutting portion may be made. The vertical outer cutting portion 76 can be prepared while sawing through an outer slot 77a defined between the body 75b of the vertical cutting guide 72 and the outer arm portion 77c. The vertical outer cutting portion 76 may be prepared with reference to the outer surface 77 of the vertical cutting guide 72. It will be appreciated that the vertical outer cut 76 may be prepared with reference to the outer arm 77c at the same time. A vertical pin 78 without a head can be placed through a partial hole 79 (FIGS. 11 and 12) provided in a vertical cutting guide 72 pushed into the anterior tibia T. Both the vertical inner cut 74 and the vertical outer cut 76 are prepared using a saw blade having a tooth or cutting structure that is aligned to form the radius cuts 30 and 32 identified in FIG. can do. In addition, by introducing roundness to the transition portion, the bone (FIG. 4) at the transition portion between the inner plateau 14 and the outer plateau 16 and the ACL island 28 is crossed by 90 degrees. Sometimes it is stronger. Next, the vertical cutting guide 72 is removed from the vertical pin 78 without the head. The medial side of the tibia T may then be cut horizontally.

  [0059] Referring to FIG. 12A, a cross-sectional view of the cutting guide 72 is shown. 12B and 12C show an alternative vertical cutting guide 72 '. Unless otherwise described herein, the cutting guide 72 'includes features similar to the cutting guide 72, and these features are identified by the same reference number followed by a dash. The cutting guide 72 'provides a capture vertical inner slot 75a' and a capture vertical outer slot 77a '. Specifically, the upper inner wall portion 80 and the upper outer wall portion 82 close the respective vertical inner slots 75a 'and vertical outer slots 77a'. The upper inner and outer walls 80 and 82 can assist in holding the saw blade in the respective inner and outer slots 75a 'and 77a'.

  [0060] At this point, the inner side gap may be confirmed to have spread using the 8/9 mm spacer block 100 (FIGS. 13-14). If the 9 mm spacer portion 102 has too much room, it is necessary to further remove the tibia. This can be done simply by turning the rotary scale and lowering the ablation block by 1 mm. If the medial side expansion gap is sufficient, the lateral side of the tibia T is cut horizontally with the vertical pin 78 without a head left in place. A vertical pin 78 without a head prevents cutting under the ACL island 28.

  [0061] As shown in FIGS. 15-17, the anterior bone can be removed using the bone forceps tool 108 to reliably round the corners of the anterior island. The ACL island file 120 (FIG. 18) is then used to finish the resected tibia T so that there are never rough edges around the ACL island 28 and each of the inner and outer plateaus 14 and 16. The tibial plateau angle gauge 130 (FIG. 19) is used to verify that the tibial slope cut has equal magnitude tilt. This is important for proper fixation of the tibial baseplate and is important for proper wear and function of the device.

  [0062] Referring now to FIG. 21, tibial dimension measurement for a complete and functional ACL will be described. It is confirmed that the inner and outer gaps are accurate using the spacer tool 140. A series of 1 mm spacers 142 may be magnetically attached as needed. The rotation and tilt may also be confirmed to be accurate. As an option, the tibia T may be measured using the anterior-posterior dimension measuring instrument 143 (FIGS. 22 and 23).

  [0063] The tibia T may then be sized using the tibial template 144 (FIGS. 24-25). The tibial template 144 includes a generally U-shaped body portion 146 that includes an outer side portion 148 and an inner side portion 150. An outer passage 152 and an outer front drill guide 154 may be provided on the outer side 148. Similarly, an inner passage 162 and an inner front drill guide 164 can be provided on the inner side 150. Since the rotation is determined by the position of the ACL island 28, it is important to confirm the correct rotation. Foundation rotation can be performed with respect to the tibial nodule and the condylar axis. At this point, extramedullary alignment can be verified by passing a 0.635 cm (1/4 inch) alignment rod through the handle 170 of the tibial template 144. A slight outward rotation is preferred to optimize patellofemoral tracking. Once the final rotation is measured, the position can be marked by extending the anterior mark of the tibial template 144, such as by using an electric knife on the anterior tibia. Position indicating pins 173 extending from the anterior-posterior dimension measuring device 143 can be installed around the posterior edge of the tibia T. Special care should be taken to prevent the tibial template 144 from rotating inward due to the outer soft tissue.

  [0064] The preparation of the tibia for a complete and functional ACL will now be described. With the tibial template 144 properly positioned, eg, with a pin 174 (FIG. 26), a drill 175 can be used to prepare the anterior hole with reference to the outer anterior drill guide 154. A tibial mask 176 may be attached to the tibial template 144. In one example, a 1/8 inch drill 175 may be used (FIG. 26). Next, another front hole can be drilled using the drill 175 with reference to the inner front drill guide 164.

  [0065] With the tibial plate 144 secured in place, the toothbrush keel blade 190 can be used to prepare both the medial and lateral tibias for the keel baseplate. Specifically, a toothbrush keel blade 190 can be inserted through the outer passage 152 and the inner passage 162 (FIGS. 28 and 29). While preparing the tibia T, a tibial trial assembly 200 (FIGS. 30 and 31) can be prepared. The tibial trial assembly 200 can include a tibial tray trial 202 and a tibial tray trial insert 204. Once the tibia is ready, the tibial template 144 can be removed from the proximal tibia. The tibial tray trial 202 can have multiple versions providing various dimensions. Similarly, the tibial tray trial insert 204 can also provide various dimensions to suit specific patient needs. The tibial tray trial insert 204 includes a peg 210 and a keel 213. The peg 210 is spaced apart corresponding to a passage previously made using the drill 175. Similarly, the keel 213 has dimensions suitable for insertion into a groove prepared using a toothbrush keel blade 190. As shown in FIG. 33, the tibial tray trial 202 is shown being struck into the tibia T using a tibial impactor 232. Using a bearing trial handle tool 228 with a lateral tibial bearing trial 224 and a medial tibial bearing trial 226 on a tibial tray trial 202 as illustrated in FIGS. Can be installed and tried. Additionally, the tibial tray trial 202 can be positioned using the bearing trial handle tool 228 (FIG. 34). As shown in FIG. 37, the range of movement can be confirmed using the femoral trial 240.

  [0066] The descriptions of the above embodiments are provided for purposes of illustration and description. The description of the above embodiments is not intended to be exhaustive or to limit the disclosure. Individual elements or features in a particular embodiment are generally not limited to that particular embodiment, are interchangeable and, where applicable, may be specifically shown or described. If not, it can be used in selected embodiments. Individual elements and features in certain embodiments may also be modified in many ways. Such modifications are not considered to be a departure from the present disclosure, and all such modifications are intended to be included within the scope of the present disclosure.

Claims (12)

An instrument set for preparing the proximal tibia during a bilateral holding procedure,
A tibial resection block configured to be secured to an anterior portion of the proximal tibia and defining a slot extending inwardly and outwardly when secured to the proximal tibia;
A vertical cutting guide having a body, an inner arm and an outer arm, wherein an inner cutting slot is defined between the body and the inner arm, and an outer cutting slot is defined between the body and the outer arm. And further comprising a tongue extending from the cutting guide so that the tongue is received in the slot of the tibial resection block and slidably translates inward and outward along the slot. Configured with a vertical cutting guide, and
A said cutting guide of the locking arm portion attached to the main body between said inner cutting slot and said outer cutting slot, said cutting guide is locked can be moved parallel to the inward and outward relative to the tibial resection block A locking position that is rotatable between a non-locking position and a locked position in which the locking arm engages the tibial resection block and prevents the cutting guide from moving relative to the tibial resection block Arms,
Instrument set with. Said locking arms is provided with a finger extending from the locking arm portion, the tibial resection block engages when in the position where the finger is the lock, instrument set of claim 1.   The instrument set of claim 1, wherein the body of the vertical cutting guide is open at the inner cutting slot and the outer cutting slot.   The instrument set of claim 1, wherein the inner cutting slot and the outer cutting slot terminate in a partial hole configured to receive a pin.   The instrument set of claim 1, wherein the body of the cutting guide has an upper inner wall and an upper outer wall.   The instrument set according to claim 1, further comprising an alignment guide, the alignment guide having elongated arms configured to be installed on both sides of the cutting guide body.   The instrument set of claim 1, further comprising a tibial resection guide, the tibial resection guide having a stylus configured to engage a lowest point of the medial tibial plateau.   The instrument set of claim 1, further comprising an inner spacer configured to be positioned on a resected inner side of the proximal tibia to identify an inner side gap.   The instrument set of claim 1, further comprising an outer spacer configured to be positioned on a resected outer side of the proximal tibia to identify an outer lateral gap.   The instrument set of claim 1, further comprising at least one pin configured to be positioned through a hole defined in the vertical cutting guide to secure the vertical cutting guide to the proximal tibia. A tibial template having a U-shaped body, an inner passage and an outer passage, and an inner drill guide and an outer drill guide;
The instrument set according to claim 1. A tibial tray trial insert, an installation peg extending from the trial insert, an installation keel extending from the trial insert;
The instrument set of claim 1 further comprising:

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